The spine, or back bone, is the essential core of the human’s skeletal structure. It serves to connect the body’s musculoskeletal system. With axial and transversal stability, the spine facilitates the body’s mechanical movement, sitting, bending, twisting, standing, and walking, whilst also giving the body shape and posture, and offering protection to the spinal cord.
The human spine has evolved to consist of 3 naturally developed curves giving it an S-shaped appearance. Unlike the apes whose spine has not evolved in the same way and remains as a structure with 1 single C-shaped curve.
Developing prenatal, and immediately postnatal a child has 33 separate vertebrae making up the spine. As the child grows and develops some of these vertebrae fuse together. This fusing occurs at the base of the spine, 4-5 (S01-S05) to create the sacrum, likewise 4-5 (V01-V05) fuse to create the coccyx. Reaching adulthood, the human averages 24 separate vertebra.
Although being a robust structure, the spine remains vulnerable to injury, disease, and abnormalities. Abnormalities are perhaps more common than most people realize. One of the most common abnormalities is known as scoliosis. The numbers of people with this condition varies across the world. In Thailand there are around 10,000 registered cases, with many more undiagnosed. In the United States sufferance is between 2 and 3 percent of the population.
What is Scoliosis?
Quite simply, scoliosis is an unnatural, sideways curvature of the spine. When viewing the spine from the rear, it appears straight. From this viewpoint, a spine with scoliosis will appear to have a sideways curve. The degree, or severity of the curve can vary greatly, and is directly linked to the degree of flexibility impairment experienced by the sufferer.
It is not uncommon for newborns to exhibit some degree of scoliosis, however, in most cases of infantile scoliosis the condition will correct itself as the child grows and the spine develops. The least common form of this abnormality is congenital scoliosis. This is when the vertebrae fail to develop correctly as the fetus grows in the womb.
By far the most common type of scoliosis, affecting around 80 percent of sufferers, is designated as being idiopathic. ‘Idiopathic’ denoting that there is no definitive cause of the condition. Idiopathic scoliosis usually becomes apparent in the sufferer as they enter their teen years.
The second most common form of the condition is neuromuscular scoliosis, sometimes called myopathic scoliosis. This form of the condition stems from the body’s nerve or muscular systems, which may have occurred due to damage to the spinal cord. Additionally, other medical conditions can bring the onset of neuromuscular scoliosis, such as spina bifida and cerebral palsy.
Osteoarthritis of the spine, which is also known as spondylosis, causes degenerative scoliosis. Scoliosis is classified as such when the sideways curvature of the spine reaches, or exceeds, 10 degrees. This form of the condition is likely to worsen as the sufferer ages.
Scoliosis Diagnostics
It is essential that diagnosis is conducted early, and by a doctor with specific knowledge, skills, and training in spinal health issues. At the Children’s Scoliosis Center in Bangkok highly trained specialists undertake the detailed diagnostics procedure necessary to determine the possible cause and severity of the condition.
Initially a child will be given a visual assessment which is conducted to confirm the existence of a spinal curvature. The specialist can also utilize spinal radiograph testing, X-ray analysis, CT and MRI scanning which give more detailed visual imaging. It is also vital that, following diagnosis, a child has periodic assessments to monitor the condition as they grow and develop.
With the results of these diagnostic procedures, using the Cobb method, the curvature can be accurately measured. Positive diagnosis of the condition when the coronal curvature reaches 10 degrees. A curvature of between 25 and 30 degrees is classified as ‘Significant’. Should the curvature exceed 45 degrees, then it is considered to be ‘Severe”.
Scoliosis Treatment
Firstly, it must be stressed that scoliosis that has not corrected itself during early years growth, cannot be cured. There is, however, treatment and therapy that alleviate the symptoms and suffering caused by the condition. To maximize the positive effects of these procedures, early diagnosis is essential.
By far the most common therapeutic approach is through physical therapy. This focuses on lifestyle and exercise. The sufferer will be made aware of, and instructed on, correct posture and stance. Given the spinal curvature, a sufferer will be guided in the optimum positions for sitting, standing, and walking.
Customized exercise routines will be developed for individual sufferers by skilled therapists at the Scoliosis Center. These may include latissimus stretching, abdominal presses, pelvic tilts, and balance practices. Under supervision, the patient learns the correct way to undertake the exercises and the frequency to which they should be practiced. This enables the sufferer to continue with self-therapy outside of clinical visits.
Bracing is a less conservative treatment method. This involves a body brace being worn by the sufferer. The type of brace will be specific to the degree of severity of the scoliosis. The brace is designed to slow down or stop the progressive tendency of the curvature to worsen. Although this can be an effective treatment, it does affect the patient’s mobility and can cause a degree of discomfort.
Should the condition continue to worsen after non-invasive and more conservative treatment methods, surgical procedures may be considered for the most extreme cases. Surgery for scoliosis involves spinal fusion. The procedure involves realignment of the curved vertebrae and then fusing them into one single bone.
The most common form of this surgery is referred to as fusion with instrumentation. Artificial implants are used to straighten the curvature in sufferers with a curvature exceeding 45 degrees. This procedure will only be carried out on children once the spine has fully developed. Nominally, 14 years of age for girls, and 16 years of age for boys.
Surgical correction of the spine is a delicate, complicated, and highly skilled procedure. The Children’s Scoliosis Center in Bangkok has a team of renown, international trained surgeons well versed in spinal surgery. The dedication of the center’s team has helped many sufferers of scoliosis, not just the Indigenous population, but for expats and visitors from across the world seeking the best possible medical care.
